Is Your Medicare Advantage or Part D Prescription Drug Plan Changing?

By Kelly Spors |

Here’s how to find out—and what you can do about it during Medicare open enrollment.

SilverSneakers Medicare Advantage or Prescription Part D

From October 15 to December 7, you can review and change your Medicare coverage to make sure it fits your current needs. During this time, we’ll provide useful information and tips to help you along the way.

Medicare open enrollment runs from October 15 to December 7 every year. Use this period to determine what new plan options have become available and assess whether your current plans are still best for you. Your options may change year to year, especially if you have a Medicare Advantage plan (Part C), which are managed care plans offered by private insurance companies that provide all Original Medicare (Part A and Part B) benefits.

“We get a lot of questions around Medicare open enrollment because it can be frustrating when someone finds out there’s been a major change to their coverage,” says Terry Brauer, a fee-only Medicare advisor and CEO of HealthCare Initiatives in Evanston, Illinois. “That’s why it’s so important that people use this time to really evaluate their coverage and see what else is out there.”

How can you make the most of Medicare open enrollment? Follow this simple five-step plan.

Step #1: Determine If Your Current Coverage Is Changing

If you have a Medicare Advantage plan or Medicare Prescription Drug Plan (Part D), you should receive an Annual Notice of Change from your insurer each September that explains changes to your plan in the year ahead. Similarly, if your current plan is being discontinued, your insurer must notify you before Medicare open enrollment.

Review these documents carefully to determine what exactly is changing. Medicare Advantage plans, in particular, are known for making annual changes—and sometimes significant ones. A plan may alter its cost structure (the premiums and out-of-pocket expenses you pay for health care services or drugs) or the benefits it offers. It may also change the network of health providers that it covers, which might be a deal-breaker if you discover a preferred doctor or hospital is no longer in network.

Step #2: Use These Tools to Compare Your Options

There are several resources—both online and offline—to help you find and assess Medicare plans available to you. A good starting place is Medicare Plan Finder, a tool through the U.S. government’s official Medicare site. You can just enter your zip code or you can provide more personalized information, and the tool shows you plans available in your area, basic coverage information, and premium costs. You can also type in the prescription drugs you take to find out how the various plans cover those drugs.

State Health Insurance Assistance Program (SHIP). Every state has a SHIP that provides free one-on-one Medicare counseling to its residents. Find contact information for your SHIP here.

Fee-only Medicare advisors. A fee-only advisor can review your current coverage and help you compare it to other coverage options available. Since they are fee-only, they aren’t being paid to steer you toward a particular plan or insurer.

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Step #3: Check the Star Rating

The Centers for Medicare and Medicaid Services rates Medicare Advantage and Part D plans on a scale of one (poor) to five (excellent) stars. The ratings are based on member experiences, services (such as screenings to stay healthy or treatments to manage chronic conditions), costs (such as accuracy of drug pricing), and several other factors. Medicare Plan Finder shows you the star rating for every plan it’s rated.

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Step #4: Unearth the Hidden Landmines

Two Medicare plans may look almost identical on the surface, especially if you’re just comparing costs such as deductibles, copayments, and out-of-pocket maximums. But delve deeper to do a true comparison. You might, for example, discover that one Medicare Advantage plan has a much larger network of health providers geographically than another—or one plan doesn’t include your doctor or hospital of choice.

Copays of both Medicare Advantage and Part D plans can also differ dramatically, Brauer says. That could mean “thousands of dollars” to you per year. Make sure to check the drug formulary—a list of covered drugs—put out annually by every plan to find out the cost of any drugs you take regularly. One plan might have a much lower price for that drug than another, even at the same insurer. You can check with insurers directly and inquire about drug pricing for particular plans.

Step #5: Consider the Extra Benefits

Medicare Advantage plans often offer additional benefits including vision, dental, and hearing coverage, and fitness memberships such as those offered by SilverSneakers. Take these additional benefits into consideration when comparing the value of one plan over another—as they may be particularly valuable to you if you take advantage of them.

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